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[florentinella]

Hi everyone,

This is going to be a long question - my apologies in advance.

I went through an early menopause I was diagnosed at 40 (actually - one day before my 40th birthday!) in 2014.

I had my second child when I was 38, I then breastfed her for about 10 months so I wasn't worried about my period not coming back - assumed it was normal... After stopping breastfeeding I had 2 periods over 1 year... then summer came and I nearly died from all the hot flushes I was experiencing...
I went to the doctor, had the tests done, and I was told I have already gone through menopause! This was 2014.
My levels at the time where (not sure if this is useful to know):
FSH 71.6
LH 38.2
prolactin 140
progesterone <1
oestradiol 38

In Nov 2014 I started using Evorel Sequi - it brought my periods back  but the hot flushes went away and I could sleep at night ...
The problem was that my periods became really long - I would bleed for 14 days i.e. half of the time! I went onto FemSeven for a couple of months but then the hot flushes came back and I was still bleeding for a long time. So I went back to Evorel Sequi patches but the dose was upped to 75mg (this was 2015) and I have been on Evorel Sequi 75mg ever since.

To be honest I'm not sure if it's working - I'm irritable, I simply cannot lose weight, my libido is non-existent
But I was told to continue until I'm 51- so until 2025.

In the meantime I have moved countries and Evorel Sequi is not available here. I brought with me a year's supply (!), but I have just finished it. The doctor here prescribed me Estradot patches 75mg + Utrogestan progesterone 100 mg capsules.

I started using them on the 1st Sept
On the 15th Sept I started bleeding and I'm still bleeding.
Normally (on Evorel Sequi) I should start bleeding only on the 25th - for about a week. I would then start new patches on 29th and bleeding would stop within a few days.

Q: Is this breakthrough bleeding?
Q: Is this normal?
Q: Is my dose too small?

I thought that this combination of Estradot & Utrogestan will eliminate bleeding altogether?

Q: Do I need to bleed? A friend of mine is on the same meds (*although lower dose of Estradot) and she doesn't get any bleeding at all.

The doctor I went to see (GP) wasn't particularly clued up on HRT - I'm not sure if it's as popular here as in the UK, and although apparently she specialises in woman's health, she had to look things up ... So my next step is probably see a gynea but thought maybe I can ask my questions here first.

Any advice / insight will be much appreciated! Thank you!

[Hurdity]

Hi florentinella

 

You haven't said whether you are taking the utrogestan cyclically nor wether orally or vaginally.

If you are peri-menopausal - then it is normally taken cyclically. If post-menopausal - either 25  days out of 28 or daily. If you have been on Evorel sequi and have changed to continuous utrogestan then your bleeds may well be sporadic and even if post-menopausal also you may well expect to have some sort of bleeding or spotting for the first 6 months until it hopefully settles into a no-bleed regime. In any case if the dose of oestrogen is too high for the dose of progesterone you may still get breakthrough bleeding.

Menopause cannot be determined on the basis of blood tests alone so you may not have been near to menopause at 40. Also if you breastfed then it could be that your periods hadn't properly come back although perhaps they might have come back more regularly if you were not approaching menopause.

If the bleeding is as a result of your own cycle kicking in then it is most likely normal bleeding.

No you don't need to bleed but whether or not you do depends on the above. The chief thing is to keep your lining thin and to have the right balance of oestrogen and progesterone that will do so - for you.

Hurdity x

[florentinella]

Hi Hurdity,

Thank you so much for your reply. I don't know where to start - I have so many questions now and I'm worried!

So to answer your question - I'm taking it every day orally.

I just checked the "info sheet" - it does say that the usual dose is 200mg on days 15-26 - and I might have a withdrawal bleeding after this time

Alternatively 100mg days 1-25 withdrawal bleeding being less.

I asked the doctor for the option with no bleeding - hence probably that's why she recommended option 2???

I have been on Evorel Sequi for 6 years now  - but this was on the assumption that I have already gone through menopause - do I understand correctly that you are saying that I might not have?? I definitely needed the medication as the hot flushes were killing me.

I have only just started with Estradot & Utrogestan (first month) so I guess I would need to wait to see if it settles?

My lining has been checked on yearly basis, and it has been thin - but as I said on Evorel Sequi I used to bleed on monthly basis and I assume this kept the lining thin.

My Questions:

So what happens to the lining if I don't bleed? Would it just got built up?

How do I know if the oestrogen is too high for progesterone?

How can I check whether I have gone or I'm still going through menopause? Should I check it? I mean do I need to know this?

If I'm on HRT - can my cycle still kick in?

I stopped breastfeeding in May 2013, my diagnosis was Aug 2014. In that time (15 months) I had two periods. My hot flushes were unbearable that summer of 2014. I started taking Evorel Sequi in Dec 2014. Is it possible that my cycle is only kicking in now? I don't want to go off the meds to test this theory...

Looking forward to your reply, thank you so much!
F xx